Provider Demographics
NPI:1164941092
Name:LONGEVITY METRICS MEDICAL GROUP INC
Entity Type:Organization
Organization Name:LONGEVITY METRICS MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:DEC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-632-2704
Mailing Address - Street 1:34145 PACIFIC COAST HWY # 803
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-2808
Mailing Address - Country:US
Mailing Address - Phone:949-632-2704
Mailing Address - Fax:
Practice Address - Street 1:34145 PACIFIC COAST HWY # 803
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-2808
Practice Address - Country:US
Practice Address - Phone:949-632-2704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)Group - Single Specialty